CMS ECAT · Starting 2027

Your Emergency Department’s performance is about to become public record.

Starting in 2027, CMS begins collecting four new ED access and timeliness metrics — measures that will be searchable and benchmarked against peer hospitals on Medicare’s Care Compare website. Emergency Care Partners will help your hospital get ready before their performance is public.

Request Your ECAT Assessment What CMS is measuring →

Who Is ECP?

We've been achieving these metrics long before CMS made them public.

Emergency Care Partners is a physician-owned partnership of leading independent emergency medicine groups, improving ED performance through clinical and operational excellence. We've helped partner hospitals across the country prepare for exactly the kind of scrutiny ECAT introduces.

Partner With ECP

Our Partner Hospitals Achieve

< 15 minDoor-to-provider

< 1%Leave before evaluation/LWBS

< 150 minOverall ED LOS (all patients)

< 60 minBoarding time (admit order → ED departure)

A Quick Win for ECAT

A well-run ED observation unit directly protects your ECAT numbers.

Two of the four ECAT metrics — extended boarding and prolonged length of stay — exclude observation-status patients entirely.

ECP has designed and run ED-led observation units for over a decade, including at some of the busiest Level I trauma centers in the country — with jointly-built specialist protocols, 24/7 on-site medical direction, and data-driven oversight. The result of ECP’s ED-run obs units is better patient outcomes, a stronger patient experience, and lower cost of care — all while directly protecting your ECAT performance.

What is CMS Measuring?

Four thresholds. One composite score.

The Emergency Care Access and Timeliness (ECAT) measure isn’t manually abstracted — it’s an electronic clinical quality measure (eCQM) pulled directly from your EHR. The denominator is every ED visit; the numerator counts any visit that missed at least one of four thresholds.

For years, medians and averages told a comfortable story while patients slipped through the gaps. ECAT counts every one of those patients — and so do we.

Wait Times

More than 1 hour from arrival to being placed in a treatment room.

Boarding

Admitted patients held in the ED over 4 hours after the admission decision.

Length of Stay

Overall ED stay exceeding 8 hours for patients eventually discharged.

Left Without Evaluation

Patients who leave before a qualified clinician performs an evaluation.

ECAT Reflects a CMS Shift

ED throughput is now a patient-safety risk — with measurable clinical and financial consequences.

“Every day across the country, emergency physicians are caring for admitted patients in hallways, storage areas, and any space that can safely hold a stretcher because there simply are not enough inpatient beds,” said ACEP President L. Anthony Cirillo, MD, FACEP. “You cannot fix what you refuse to measure. This new Emergency Care Access and Timeliness measure is an essential first step toward real accountability for ED boarding and toward getting patients out of hallways and into beds so that they can get the care they need with the dignity they deserve.”
— ACEP Statement on CMS 2026 OPPS Final Rule, Nov 2025

18.5% → 28.7%

of ED visits involved an access failure — up sharply from 2017 to 2024.

~2×

Prolonged length of stay nearly doubled over the same period.

>2×

Boarding delays more than doubled — and the trend is worsening.

Source: Sangal et al., “Emergency Care Access Based on a Proposed CMS National Quality Measure,” JAMA Health Forum, 2025 — national EHR data covering 148M+ ED encounters, 2017–2024.

The Clock Is Ticking

3 hard deadlines.
Less runway than it looks.

Jan 2027

Voluntary Reporting

Hospitals begin submitting ECAT data to CMS to validate capture and surface performance gaps.

Jan 2028

Public Reporting

ECAT becomes a required part of the Hospital OQR Program, replacing the older LWBS and Median Time to Discharge measures.

Jan 2030

Payment Penalties

Hospitals that fail OQR reporting requirements — including ECAT — face a payment penalty.

Local Leadership. Measurable Results.

Boarding and length of stay aren’t just ED problems — they’re hospital-wide problems.

Solving these problems takes seasoned local leadership — an ECP physician partner who knows your hospital, your medical staff, and the community you serve well enough to drive change across departments. Not a rotating regional administrator, but a local physician leader who sits on your committees, supports inpatient throughput and boarding efficiencies, and is present on the ground to see the work through.

98%

ECP has a 98% physician partner retention rate — meaning the medical director working your ECAT strategy today is still there next year — and the year after, when mandatory reporting hits and your board wants answers.

GET READY BEFORE 2027

How will your ED perform when the data goes public?

Talk to ECP about where your hospital stands today — and what it takes to be ready before public reporting begins.

Medicine is Local.

Hospitals Partners Working With Data Contact